Inflammatory pseudotumour of the liver: the residuum of a biliary cystadenoma?

Inflammatory pseudotumour is a rare form of a liver mass. We report the case of a 28-year-old man presenting with obstructive jaundice, in whom an inflammatory pseudotumour arose with the resolution of a mucus secreting cystic liver lesion. The initial features suggested an intrahepatic cystadenoma or cystadenocarcinoma, which on its involution left a solid mass. Histopathology showed an inflammatory pseudotumour with no evidence of malignancy. A similar case has been reported recently, with the development of an inflammatory pseudotumour following collapse of a liver cyst seen on imaging. These two cases may shed some light on the origins of these rare liver lesions.     

Anaplastic carcinoma associated with a mucinous cystic neoplasm of the pancreas during pregnancy： Report of a case and a review of the literature

Oncogenesis of anaplastic carcinoma of the pancreas is a subject of controversy, because it shows sarcomatous nature with extremely poor prognosis. We herein report an unusual case of anaplastic carcinoma occurring with a recurrent mucinous cystic neoplasm in a 38-year-old female. A 10-cm retroperitoneal cystic mass was pointed out in the first pregnancy and a probable diagnosis of mucinous cystic neoplasm was made in October 2000. She refused surgery first and delivered her baby uneventfully. During her second pregnancy in 2002, however, she presented hematemesis and underwent urgent distal pancreatectomy, splenectomy and partial resection of the gastric wall where the tumor perforated. A diagnosis of borderline-type mucinous cystic neoplasm with ovarian-like stroma was made. Nine months later, CT visualized a recurrent cystic tumor near the pancreatic stump, which was subsequently resected. Pathology revealed that the tumor was composed of two different components of borderline-type mucinous cystic neoplasm and anaplastic carcinoma. The latter was intensely positive for vimentin, CD68, p53 and focally for cytokeratin, suggesting both sarcomatous and carcinomatous differentiation. She survived four years after the second surgery without tumor recurrence. Although the origin of anaplastic carcinoma has not been determined yet, it should be remembered that anaplastic carcinoma can occur in association with mucinous cystic neoplasm of more benign histology.     

Is a statin as part of a polypill the answer?

Statins are a necessary component of a polypill. Almost all patients have the potential to benefit from low-density lipoprotein cholesterol reduction with statins, although absolute benefits due to the reduction in coronary heart disease and stroke vary by risk level. The reduction in coronary heart disease and stroke from antihypertensive therapy is additive to the reduction in risk from statins. Used in combination with antihypertensive therapy, a moderate-dose statin would be expected to reduce cardiovascular risk by at least 50%, and a high-dose statin would be expected to reduce risk by at least 60% over an approximately 5-year period. A polypill containing aspirin in addition to a statin and antihypertensive therapy would be appropriate for most men over age 55 years, but not for high-risk women until age 65 years and moderately high-risk women until age 75 years. Polypills in development hold great promise for reducing the global burden of cardiovascular disease.     

The pars tuberalis of the hypophysis: a modulator of the pars distalis?

The pineal hormone melatonin is known to influence circadian systems. Melatonin is also ascribed to mediate photoperiodic effects on the regulation of the hypothalamo-hypophyseal-gonadal axis. Other endocrine actions, especially a thyrotropic influence, have been postulated. Site and mechanism of action of melatonin, however, are still matters of speculation. In search of a functional cascade of (i) photoperiodic stimuli, (ii) their hormonal messenger melatonin, and (iii) endocrine targets, the pars tuberalis has gained a key position. The recent discovery and characterization of melatonin receptors located in the pars tuberalis of several species support such a functional significance. Earlier results point to a functional connection of the pars tuberalis with the pineal gland: the pars tuberalis is known for a pattern of differentiation distinctly different from other parts of the adenohypophysis. It contains a specific cell population with a morphology typical of peptide secreting cells. Like the hypothalamic nerve endings of the median eminence, they are in close contact with the primary plexus of the portal system. In contrast to secretory cells of the pars distalis, the specific cells of the pars tuberalis do not respond with morphological alterations to functional changes of peripheral endocrine glands. Yet, photoperiodic stimuli obviously influence morphology and functional activity of the pars tuberalis-specific cells. Investigations during recent years have led to the tentative conclusion that the pars tuberalis represents the hypophysial "receptor" for melatonin as the chemical messenger of photoperiodic stimuli. Depending on melatonin secretion pattern and melatonin receptivity, the pars tuberalis seems to modulate at least gonadotropic and thyrotropic activity of the pars distalis via a peptide hormone distributed in the pars distalis by the portal plexus.(ABSTRACT TRUNCATED AT 250 WORDS)     

Does the use of mean or median Z-score of the thyroid volume indices provide a more precise description of the iodine deficiency disorder status of a population?

Endemic iodine deficiency is largely an environmental problem affecting whole populations. Currently, thyroid volume data from a population are analyzed with the sole objective of obtaining an estimate of goitre prevalence using +97th percentile or +2 standard deviations of an appropriate reference as cut-off. This paper proposes an alternative approach to the analysis and presentation of thyroid volume data using Z-scores (standard deviation scores) of the thyroid volume indices such as thyroid volume-for-age or thyroid volume-for-body surface area. The calculation of the summary statistics of the Z-scores, such as mean or median, provides an alternative to the prevalence-based approach for expressing severity of iodine deficiency disorders (IDD). An advantage of the mean or median Z-score is that it describes the thyroid volume profile (and therefore the IDD status) of the entire population directly, unlike goitre prevalence which gives information only about the extremes of distribution. The frequency curve or histogram of the Z-scores provides a complete picture of the whole distribution. Although qualitatively similar conclusions on IDD severity can be drawn from both analytical approaches, only the Z-score system is able to capture adequately the trends or changes in thyroid size over time, and to establish whether a previously iodine-deficient community's thyroid volume profile has returned to 'normal' (as indicated by a distribution that is not significantly different from that of the reference) following intervention. As a continuous variable, Z-scores are particularly useful for the analysis of data from populations where the sample size is relatively small, or where many individuals lie outside the extreme percentiles of the reference population. In view of its advantages in the context of activities based on single and multiple measurements, the Z-score system is to be preferred for the reporting and use of thyroid volume indices. A desirable consequence of this preference is that national goals will be oriented towards an improvement of the overall thyroid volume profile of the population, rather than just a reduction of the number of individuals at the extremes.     

Is there a referral bias in the diagnoses of patients of a memory clinic?

In a recent study addressing the contribution of neuropsychology and neuroradiology to the improvement of the dementia diagnoses of a memory clinic more than 45% of the patients (45 out of 101) did not meet the criteria for dementia. This finding was unexpected because all patients had been referred for the diagnosis and differential diagnosis of dementia. The aim of the present study was to examine whether the proportion of nondemented patients varies with the "modus of referral". This was not found to be true. The frequency of the diagnosis "no dementia" was not significantly different for the two patient groups "general practitioner" vs. "neuropsychiatrist" referred patients (p=0.859). In conclusion, there is no difference between the two groups of physicians in the reliability judging whether a "cognitive complainer" needs to be referred to a specialized memory clinic.     

Huge primitive neuroectodermal tumor of the pancreas： Report of a case and review of the literature

INTRODUCTION Primitive neuroectodermal tumors (PNETs) are small round cell tumors arising from soft tissue belonging to the Ewing’s sarcoma family. These neoplasms all exhibit a neural phenotype, express the MIC2-protein (CD99) and display the same chrom…     

Is there a role for chemoradiation in the management of cystadenocarcinoma of the pancreas?

Despite a paucity of data, cystadenocarcinoma of the pancreas has been considered to be resistant to chemoradiation, with a limited effect similar to that of the more common pancreatic adenocarcinoma. We describe a case of a partially excised cystadenocarcinoma with a positive surgical margin that was treated by neoadjuvant chemoradiation. No epithelial elements were found on histologic examination after reresection. Three previous cases of dramatic response of pancreatic cystadenocarcinoma to chemoradiation have been described in the literature. The current dogma alleging poor response of pancreatic cystadenocarcinoma to chemoradiation may be in error.     

Indeterminate colitis: a review of the concept--what's in a name?

The precise diagnosis of colitis cannot always be established with the available diagnostic tools. The subgroup of patients with an uncertain diagnosis has been classified as "indeterminate colitis" (IC). The definition of "indeterminate," however, has changed over the years. Originally, IC was proposed by pathologists for colectomy specimens, usually from patients operated on for severe colitis, showing overlapping features of ulcerative colitis (UC) and Crohn's disease (CD). Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, and other features allowing a diagnosis of either UC or CD. Therefore, it is difficult to compare different studies. An International Organization of Inflammatory Bowel Diseases (IOIBD) working party confirmed 1) the ambiguous nature of the term, and 2) proposes an updated classification for the category of patients with an unclear diagnosis. According to this, the term IBD unclassified (IBDU) is confirmed, as suggested by the Montreal Working Party 2005 for patients with clinically chronic colitis, that clearly have IBD but when definitive features of CD or UC are absent. In resected specimens the term "colitis of uncertain type or etiology" (CUTE) is preferred. It is accepted that most of the time this may have a prefix, such as severe, chronic. The classification of IBD varies when based only on biopsies rather than on a colectomy specimen. The vast majority of these have severe colitis. For those that cannot bear to abandon the highly ambiguous term IC, if it is used at all, this is where it can be used parenthetically.